MDAST 322 Chapter 15 EXAM NEWEST ACTUAL EXAM COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+||BRAND NEW VERSION!!

MDAST 322 Chapter 15 EXAM NEWEST ACTUAL EXAM COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+||BRAND NEW VERSION!! A set dollar amount that the policyholder must pay before the insurance company starts to pay for services is the definition of: - Answer- Deductible. Patients belonging to a MCO usually are required to get a referral from their ____ before seeing a specialist. - Answer- PCP. Insurance information should be collected on the first visit. - Answer- TRUE. It is important to have a patient's insurance information so that eligibility can be determined. Only physicians can be providers of medical services. - Answer- FALSE. Nurses and other parties can provide medical services. A participating provider can bill the patient for the difference between their fee and insurance companies allowed amount. - Answer- FALSE. To become a participating provider in an insurance network, the provider must agree to accept the insurance plan's fee schedule as payment in full for services rendered. This means that if the provider's fee is higher than the plan's allowed amount, the difference should be adjusted. When the birthday rule is used to determine which policy is primary and which is secondary, it is the policy of the person who is the oldest that is considered primary. - Answer- FALSE. With the birthday rule, whichever parent's birth date falls first in a calendar year is considered to have the primary insurance. The year of the parent's birth is not used. A(n) __________ claim has been completed accurately and completely. - Answer- Clean. A set dollar amount that the patient must pay for each office visit is the definition of: - Answer- Copayment. How many diagnoses can be reported on the CMS-1500? - Answer- Twelve. Accurate patient information for submitting a health insurance claim is important, but a medical release of information form, signed by the patient, should be kept in the person's health record. - Answer- TRUE. The physician's office place-of-service code is: - Answer- 11. To examine claims for accuracy and completeness before they are submitted is to _________ the claims. - Answer- Audit. The medical assistant should __________ the front and back of the patient's insurance card. - Answer- Copy. Match the Comprehensive Care PCMH Domain with the appropriate descriptors. - Answer- Team-based approach. The provider is paid a set amount for each enrolled person assigned to them, per period of time, whether or not that person has received services is the definition of: - Answer- Capitation. The billing provider's NPI number is placed in block: - Answer- 33a. Electronic claims are submitted via the internet. - Answer- TRUE. Electronic claims are submitted via electronic media, such as the internet. Most of today's computer programs generate claims internally from the information entered into the database. Abuse is knowingly and willfully executing or attempting to execute a scheme to defraud any healthcare benefit program. Fraud is an unintended action that results in an overpayment to the healthcare provider. - Answer- Both statements are false. The National Provider Identifier is assigned by the AMA and is required to file a third party claim. - Answer- FALSE. National Provider Identifier (NPI) is an identifier assigned by the Centers for Medicare and Medicaid Services (CMS) that classifies the healthcare provider by license and medical specialties. After the deductible has been met the policyholder is responsible for a certain percentage of the bill is the definition of: - Answer- Co-insurance.